MICS Household Questionnaire

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BURKINA FASO HOUSEHOLD QUESTIONNAIRE

HELLO. MY NAME IS _______________________________________ AND I AM WORKING WITH THE

UNIVERSITY OF OUAGADOUGOU. WE ARE WORKING ON A PROJECT CONCERNED WITH FAMILY HEALTH AND

EDUCATION. I WOULD LIKE TO TALK TO YOU ABOUT YOUR HOUSEHOLD. THE INTERVIEW WILL TAKE ABOUT 40

MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL

NEVER BE IDENTIFIED. DURING THIS TIME I WOULD LIKE TO SPEAK WITH THE HOUSEHOLD HEAD AND ALL MOTHERS

OR OTHERS WHO TAKE CARE OF CHILDREN IN THE HOUSEHOLD.

HOUSEHOLD CHARACTERISTICS HC

HC1. VILLAGE ID: ___ ___ ___ HC2. HOUSEHOLD NUMBER: ___ ___ ___

HC3. INTERVIEWER NAME AND NUMBER: NAME ___ ___

HC4. SUPERVISOR NAME AND NUMBER: NAME ___ ___

HC5. DAY/MONTH/YEAR OF INTERVIEW: ___ ___ / ___ ___ / ___ ___ ___ ___

HC6. PROVINCE: HC7. DEPARTMENT:

HC8. NAME OF HEAD OF HOUSEHOLD:

_____________________________________________________

HC9. RESPONDENT RELATIONSHIP TO HEAD OF HOUSEHOLD: _____

01 = HEAD 02 = WIFE OR HUSBAND 03 = SON OR DAUGHTER 04 = GRANDCHILD

05 = PARENT 06 = BROTHER OR SISTER 07 = UNCLE/AUNT 08 = NIECE/NEPHEW

09 = OTHER RELATIVE 10 = ADOPTED/FOSTER/STEPCHILD 11 = NOT RELATED 98 = DON'T KNOW

HC10. SEX OF HEAD OF HOUSEHOLD: 1. MALE 2. FEMALE

HC11. AGE OF HEAD OF HOUSEHOLD AGE: ___ ___

HC12. HIGHEST LEVEL OF EDUCATION AND GRADE OF HEAD OF HOUSEHOLD (CIRCLE ONE): 0 NONE 4 HIGHER GRADE: ___ ___ 1 PRE-SCHOOL 5 NON-STANDARD CURRICULUM 2 PRIMARY 8 DK 3 SECONDARY

HC13. HOUSEHOLD GEO-REFERENCE: LONGITUDE: LATITUDE:

HC14. TOTAL NUMBER OF HOUSEHOLD MEMBERS: _____

HC15. TOTAL NUMBER OF CHILDREN UNDER 18 YEARS

OLD IN HOUSEHOLD: _____

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HC16A. WHAT IS THE RELIGION OF THE HEAD OF

THIS HOUSEHOLD?

MUSLIM ....................................................... 1 CHRISTIAN ................................................... 2 ANIMISM ...................................................... 3 OTHER RELIGION (SPECIFY) .......................... 6 NO RELIGION………………………………….7

HC16B. WHAT IS THE MOTHER TONGUE/NATIVE

LANGUAGE OF THE HEAD OF THIS HOUSEHOLD? FRENCH ........................................................ 1 MOORE ......................................................... 2 DIOULA ......................................................... 3 FULFUDE ...................................................... 4 GULMACHEMA ............................................... 5 BWAMU ......................................................... 6 OTHER LANGUAGE (SPECIFY)………………… 7

HC16C. TO WHAT ETHNIC GROUP DOES THE HEAD

OF THIS HOUSEHOLD BELONG? MOSSI………………………………………….1 DIOULA…………………………………………2 PEUL….………………………………………..3 GOURMANCHE…………………………………4 BWABA…………………………………………5 OTHER ETHNICITY (SPECIFY)…………………6

HC17A. MAIN MATERIAL OF THE DWELLING FLOOR: NATURAL MATERIAL (EARTH, SAND, DUNG) .................................... 1 RUDIMENTARY MATERIAL (WOOD PLANKS, PALM, BAMBOO) .................... 2 FINISHED MATERIAL (POLISHED WOOD, VINYL, ASPHALT, CERAMIC, CEMENT, CARPET) ........... 3 OTHER (SPECIFY) ....................................... 96

HC17B. MAIN MATERIAL OF THE ROOF. NATURAL MATERIAL (NO ROOF, STUBBLE) ..................................... 1 RUDIMENTARY MATERIAL (RUSTIC MAT, PALM, BAMBOO, WOOD PLANKS) ............................... 2 FINISHED MATERIAL (METAL, WOOD, CEMENT, SHINGLES) ..................................... 3 OTHER (SPECIFY) ....................................... 96

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HC18. HOW MANY OF THE FOLLOWING GOODS DO

ANY MEMBERS OF YOUR HOUSEHOLD OWN: A RADIO?

A MOBILE TELEPHONE?

A WATCH?

A BICYCLE?

A MOTORCYCLE OR SCOOTER?

AN ANIMAL-DRAWN CART?

CATTLE

RADIO ...................................... ………[____]

MOBILE TELEPHONE .................. ………[____]

WATCH ..................................... ………[____]

BICYCLE ................................... ………[____]

MOTORCYCLE/SCOOTER .......... ………[____]

ANIMAL DRAWN-CART ................ ………[____]

CATTLE..................................... ………[____]

HC19. WHAT IS THE MAIN SOURCE OF DRINKING

WATER FOR MEMBERS OF YOUR HOUSEHOLD

DURING THE RAINY SEASON?

PIPED WATER ............................................... 1 TUBE WELL OR BOREHOLE ............................ 2 DUG WELL .................................................... 3 WATER FROM SPRING ................................... 4 RAINWATER .................................................. 5 TANKER TRUCK ............................................. 6 CART WITH SMALL TANK ................................ 7 SURFACE WATER .......................................... 8 BOTTLED WATER .......................................... 9 OTHER (SPECIFY) ....................................... 10

HC20. WHO USUALLY GOES TO THIS SOURCE TO

FETCH WATER FOR YOUR HOUSEHOLD? ADULT WOMAN ............................................. 1 ADULT MAN .................................................. 2 GIRL (UNDER 15) .......................................... 3 BOY (UNDER 15) ........................................... 4 OTHER (SPECIFY)……………………………...5

HC21. HOW LONG HAVE YOU BEEN LIVING

CONTINUOUSLY IN (NAME OF CURRENT PLACE OF

RESIDENCE.

YEARS ................................................... __ __ ALWAYS/PERMANENT .................................. 95 TEMPORARY/PERIODICALLY ......................... 96

HC22. AT WHAT AGE SHOULD GIRLS STOP

ATTENDING SCHOOL? If “girls should not attend school at all”, enter 0

If no limitation, write 99. _____

HC23. AT WHAT AGE SHOULD BOYS STOP ATTENDING

SCHOOL? If “boys should not attend school at all”, enter 0

If no limitation, write 99.

_____

HC24. ARE THERE ANY CHILDREN IN THIS

HOUSEHOLD WHO CURRENTLY ATTEND

PRESCHOOL (BISONGO)?

YES .............................................................. 1 NO ............................................................... 2

HC25A. DO ANY WOMEN IN THIS HOUSEHOLD

PARTICIPATE IN MOTHER’S LITERACY TRAINING? YES .............................................................. 1 NO ............................................................... 2

HC25B. DO ANY WOMEN IN THIS HOUSEHOLD

PARTICIPATE IN LITERACY TRAINING OF ANY KIND? YES……………………………………………..1 NO………………………………………………2

HC26. HAVE YOU HEARD ANYTHING RECENTLY

ABOUT THE SCHOOLING BENEFITS FOR GIRLS? YES .............................................................. 1 NO ............................................................... 2

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AFTER THE QUESTIONNAIRE HAS BEEN COMPLETED, FILL IN THE FOLLOWING INFORMATION:

HC27. RESULT OF HH INTERVIEW: _____

COMPLETED……………………………………..1

EFFORT ENDED………………………………….2

REFUSED ............................................................. 3

OTHER (SPECIFY) ....................................... ……….4

HC28. INTERVIEWER/SUPERVISOR NOTES: USE THIS SPACE TO RECORD NOTES ABOUT THE INTERVIEW WITH

THIS HOUSEHOLD.

HC29. DATA ENTRY CLERK: _____

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HOUSEHOLD LISTING FORM Village ID: ___ ___ ___ Household Number ___ ___ ___ HL FIRST, PLEASE TELL ME THE NAME OF EACH CHILD WHO USUALLY LIVES HERE BETWEEN THE AGES OF 5 AND 12. List all household members between 5 and 12 years old in HL2, their

relationship to the household head (HL3), their sex (HL4), and their age (HL5). Then ask: ARE THERE ANY OTHER CHILDREN BETWEEN THE AGE OF 5 AND 12 WHO LIVE HERE, EVEN IF THEY

ARE NOT MEMBERS OF YOUR FAMILY, DO NOT HAVE PARENTS LIVING IN THIS HOUSEHOLD, OR ARE NOT AT HOME NOW? (INCLUDING CHILDREN IN SCHOOL OR AT WORK). If yes, complete listing.

Add a continuation sheet if there are more than 10 children between 5 and 12. Tick here if continuation sheet used

HL1.

Line

no.

HL2. CHILD’S NAME

HL2A. NAME OF CHILD’S

FATHER

HL2B. NAME OF CHILD’S

MOTHER

HL3. WHAT IS THE

RELATION-SHIP OF

(name) TO THE

HEAD OF THE

HOUSEHOLD?

Interviewer: For

this question, use

codes from HC9

HL4. IS (name) MALE

OR FEMALE?

1 MALE 2 FEMALE

HL5. HOW OLD IS (name)? HOW OLD WAS

(name) ON

HIS/HER LAST

BIRTHDAY?

Record in

completed years

98=DK

HL7. WHAT IS THE HIGHEST

LEVEL OF SCHOOL (name) ATTENDED? WHAT IS THE HIGHEST

GRADE (name) COMPLETED

AT THIS LEVEL? LEVEL:

0 NO SCHOOL 1 PRE-SCHOOL 2 PRIMARY 3 INFORMAL CURRICULUM 8 DK GRADE:

1 CP1……6CM2

If level = 0 or preschool,

write grade = 0

HL8. DURING THE

(2007-2008) SCHOOL YEAR, HAS (name)

ATTENDED

SCHOOL OR

PRESCHOOL AT

ANY TIME?

1 YES ED1 2 NO HL9 8 IF N/A

HL9. If no:

WHY IS (name) NOT

ENROLLED IN SCHOOL?

0 NO SCHOOL IN

VILLAGE 1 SCHOOL FEES 2 CHILD TOO YOUNG 3 SCHOOL TOO FAR 4 WORK FOR INCOME 5 HOUSEHOLD WORK 6 TAKING CARE OF

SIBLINGS 7 OTHER (SPECIFY)

CL1

LINE CHILD’S NAME FATHER’S NAME MOTHER’S NAME REL. M F AGE LEVEL GRADE Y N DK

01

___ ___ 1 2 ___ ___

___ ___ 1 2 8

02

___ ___ 1 2 ___ ___

___ ___ 1 2 8

03

___ ___ 1 2 ___ ___

___ ___ 1 2 8

04

___ ___ 1 2 ___ ___

___ ___ 1 2 8

05

___ ___ 1 2 ___ ___

___ ___ 1 2 8

06

___ ___ 1 2 ___ ___

___ ___ 1 2 8

07

___ ___ 1 2 ___ ___

___ ___ 1 2 8

08

___ ___ 1 2 ___ ___

___ ___ 1 2 8

09

___ ___ 1 2 ___ ___

___ ___ 1 2 8

10

___ ___ 1 2 ___ ___

___ ___ 1 2 8

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EDUCATION MODULE Village ID: ___ ___ ___ Household Number ___ ___ ___ ED To be administered for every child in the household age 5 through 12 years who attended School at any time during 2007-2008 School Year

ED1.

Line

no.

ED1A. Name

ED2. DURING THE CURRENT

SCHOOL YEAR, WHICH

LEVEL AND GRADE IS

(name) ATTENDING?

LEVEL: 0 PRESCHOOL 1 PRIMARY 2 SECONDARY 3 HIGHER 6 NON-STANDARD

CURRICULUM 8 DK GRADE: 1 CP1…6CM2 98 DK

ED3. DOES (name) HAVE ACCESS

TO A COMPLETE

SET OF

TEXTBOOKS

FOR HIS OR

HER USE? 1 YES 2 NO ED5

ED4. If yes:

HOW DID (name) OBTAIN THE TEXTBOOKS

THAT HE/SHE HAS? 1 PROVIDED BY

SCHOOL, CAN TAKE

HOME. 2 PROVIDED BY

SCHOOL, CAN’T TAKE

HOME. 3 NEWLY BOUGHT FROM

SCHOOL 4 NEWLY BOUGHT FROM

PRIVATE MARKET. 5 GIFT 6 FROM SIBLING 7 BOUGHT USED 8 OTHER (SPECIFY)

ED5. IS THE SCHOOL

THAT (name)

ATTENDS PUBLIC

OR PRIVATE

ED6. WHAT IS THE NAME OF THE SCHOOL THAT

(name) IS CURRENTLY ATTENDING AND IN

WHICH VILLAGE IS IT LOCATED? WRITE THE APPROPRIATE CODE

ED7. HOW FAR

AWAY FROM

YOUR HOME IS

THE SCHOOL

(name) HAS

BEEN

ATTENDING

DURING THE

CURRENT

SCHOOL

YEAR?

(Interviewer

record

observation)

ED8. HOW

LONG

DOES IT

TAKE

(name) TO TRAVEL

TO

HIS/HER

SCHOOL?

ED9. DID (name)

ATTEND

SCHOOL ON

THE MOST

RECENT DAY

THE SCHOOL

WAS OPEN, (DAY)? 1 YES

ED11 2 NO

LINE LEVEL GRADE YES NO TYPE OF

SCHOOL SCHOOL NAME VILLAGE NAME

DISTANCE IN

KM

ONE WAY YES NO

MINUTES

01

1 2 1 2

02

1 2 1 2

03

1 2 1 2

04

1 2 1 2

05

1 2 1 2

06

1 2 1 2

07

1 2 1 2

08

1 2 1 2

09

1 2 1 2

10

1 2 1 2

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ED1.

Line

no.

ED1A. Name

ED10. WHAT WAS THE

PRINCIPAL REASON FOR

(name) MISSING

SCHOOL? INQUIRE IF

(NAME) DID NOT GO TO

SCHOOL.

1 SICK 2 FUNERAL 3 OTHER CEREMONY 4 WORK FOR INCOME 5 HOUSEHOLD CHORES 6 FINANCIAL REASONS 7 TAKING CARE OF

SIBLINGS 8 CHILD REFUSED 9 OTHER (SPECIFY)

ED11. HOW MANY

DAYS HAS

(name’s) SCHOOL

BEEN OPEN

IN THE PAST

7 DAYS?

ED12. HOW MANY

DAYS HAS

(name) ATTENDED

SCHOOL IN

THE PAST 7

DAYS?

IF ED11 &

ED12 MATCH

ED14

ED13. WHAT WAS THE

PRINCIPAL REASON FOR

(name) MISSING

SCHOOL IN THE PAST 7

DAYS?

1 SICK 2 FUNERAL 3 OTHER CEREMONY 4 WORK FOR INCOME 5 HOUSEHOLD CHORES 6 FINANCIAL REASONS 7 TAKING CARE OF

SIBLINGS 8 CHILD REFUSED 9 OTHER (SPECIFY)

ED14. HOW OLD

WAS

(name) WHEN

HE/SHE

FIRST

ENTERED

PRIMARY

SCHOOL?

ED15. DOES (name)

PARTICIPATE IN

ANY FEEDING

PROGRAM AT

HIS/HER SCHOOL? 1 YES 2 NO ED18A 8 DON’T KNOW

ED16. WHAT KIND OF

MEAL DOES

(name) RECEIVE

AT HIS/HER

SCHOOL? 1 BREAKFAST 2 SNACK 3 LUNCH 4 OTHER

(SPECIFY) COMBINE CODES IF

THERE ARE

SEVERAL MEALS

ED17. HOW

MANY

TIMES PER

WEEK

DOES

(name) RECEIVE

THIS

MEAL?

ED18A. DOES THE SCHOOL

(NAME) ATTENDS OFFER a BISONGO?

LINE NAME REASON NBR OF DAYS DAYS AGE Yes No DK TYPE OF MEAL NUMBER

OF TIMES Yes No DK

01 1 2 8 1 2 8

02 1 2 8 1 2 8

03 1 2 8 1 2 8

04 1 2 8 1 2 8

05 1 2 8 1 2 8

06 1 2 8 1 2 8

07 1 2 8 1 2 8

08 1 2 8 1 2 8

09 1 2 8 1 2 8

10 1 2 8 1 2 8

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ED1. Line no.

ED1A. Name

ED18B. DOES THE SCHOOL

(NAME) ATTENDS

OFFER SEPARATE

BATHROOMS FOR

BOYS AND GIRLS ?

ED18C. DOES THE SCHOOL

(NAME) ATTENDS

OFFER SCHOOL

CANTEEN ?

ED18D. DOES THE SCHOOL

(NAME) ATTENDS

OFFER DRY

RATIONS FOR GIRLS

ONLY?

ED18E. DOES THE SCHOOL

(NAME) ATTENDS

OFFER DRY

RATIONS FOR GIRLS

AND BOYS?

ED18F. DOES THE SCHOOL

(NAME) ATTENDS OFFER

TEXTBOOKS?

ED19. WHAT IS THE MOST

IMPORTANT REASON TO YOU

FOR SENDING (NAME) TO

SCHOOL? 1 DISTANCE TO SCHOOL 2 BISONGO 3 TEXTBOOKS 4 SCHOOL CANTEEN 5 DRY RATIONS 6 SEPARATE BATHROOMS FOR

BOYS AND GIRLS 7 OTHER (SPECIFY)

ED20. WHAT IS THE SECOND MOST

IMPORTANT REASON TO YOU

FOR SENDING (NAME) TO

SCHOOL? 1 DISTANCE TO SCHOOL 2 BISONGO 3 TEXTBOOKS 4 SCHOOL CANTEEN 5 DRY RATIONS 6 SEPARATE BATHROOMS FOR

BOYS AND GIRLS 7 OTHER (SPECIFY)

LINE NAME Yes No DK Yes No DK Yes No DK Yes No DK Yes No DK MAIN REASON SECONDARY REASON

01 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

02 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

03 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

04 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

05 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

06 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

07 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

08 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

09 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

10 1 2 8 1 2 8 1 2 8 1 2 8 1 2 8

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CHILD LABOUR MODULE Village ID: ___ ___ ___ Household Number ___ ___ ___ CL To be administered for every child in the household age 5 through 12 years.

NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO.

CL1. Line

no.

CL2. Name

CL3. DURING THE PAST WEEK, DID (name) DO ANY KIND OF

WORK FOR SOMEONE WHO IS NOT A

MEMBER OF THIS

HOUSEHOLD? If yes: FOR PAY IN CASH OR

KIND? 1 YES, FOR PAY (CASH OR KIND) 2 YES, UNPAID 3 NO TO CL5

CL4. If yes:

SINCE LAST (day of the week),

ABOUT HOW MANY

HOURS DID HE/SHE DO

THIS WORK FOR

SOMEONE WHO IS NOT

A MEMBER OF THIS

HOUSEHOLD? If more than one job,

include all hours at all

jobs.

CL5. AT ANY TIME DURING THE PAST

YEAR, DID (name) DO ANY KIND OF

WORK FOR SOMEONE WHO IS NOT

A MEMBER OF THIS HOUSEHOLD? If yes: FOR PAY IN CASH OR KIND?

1 YES, FOR PAY (CASH OR KIND) 2 YES, UNPAID 3 NO

CL6. DURING THE PAST WEEK, DID (name) HELP WITH

COLLECTING FIREWOOD?


CLEANING?


FETCHING WATER?

LINE YES YES NO. NAME PAID UNPAID NO NO. HOURS PAID UNPAID NO YES NO YES NO YES NO

01 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

02 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

03 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

04 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

05 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

06 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

07 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

08 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

09 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

10 1 2 3 ____ ____ 1 2 3 1 2 1 2 1 2

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CHILD LABOUR MODULE Village ID: ___ ___ ___ Household Number ___ ___ ___ CL To be administered for every child in the household age 5 through 12 years.

NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO.

CL1. Line

no.

CL2. Name

CL9. DURING THE PAST WEEK, DID

(name) HELP WITH TAKING CARE

OF YOUNGER SIBLINGS?


(name) HELP TEND ANIMALS?


(name) HELP WITH FARMING?


(name) HELP WITH SHOPPING?


(name) DO ANY OTHER FAMILY

WORK (IN A BUSINESS OR SELLING GOODS

IN THE STREET?) 1 YES 2 NO TO MA1

LINE NO.

NAME YES NO YES NO YES NO YES NO YES NO

01 1 2 1 2 1 2 1 2 1 2

02 1 2 1 2 1 2 1 2 1 2

03 1 2 1 2 1 2 1 2 1 2

04 1 2 1 2 1 2 1 2 1 2

05 1 2 1 2 1 2 1 2 1 2

06 1 2 1 2 1 2 1 2 1 2

07 1 2 1 2 1 2 1 2 1 2

08 1 2 1 2 1 2 1 2 1 2

09 1 2 1 2 1 2 1 2 1 2

10 1 2 1 2 1 2 1 2 1 2

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MATH ASSESSMENT Village ID: ___ ___ ___ Household Number ___ ___ ___ MA To be administered to every child in the household age 5 through 12 years.

I AM [NAME]. I WORK WITH PARENTS AND CHILDREN. I AM TRYING TO LEARN MORE ABOUT THE DAILY LIFE OF CHILDREN LIKE YOU. I WOULD LIKE TO GIVE YOU A SHORT TEST IN MATH AND FRENCH. I AM GOING TO READ

YOU A SET OF QUESTIONS. YOU SHOULD GIVE THE ANSWER THAT FITS BEST. IF YOU DON’T UNDERSTAND THE QUESTION, I WILL READ THE QUESTION AGAIN. YOU CAN ASK ME ANYTIME TO EXPLAIN A QUESTION. YOU CAN

CHOOSE NOT TO ANSWER, OR YOU CAN TELL ME IF A QUESTION IS HARD FOR YOU AND WE WILL SKIP THAT QUESTION. IF YOU LIKE, YOU CAN END THE INTERVIEW AT ANY TIME. DO YOU UNDERSTAND?

If the child understands, continue. If the child does not understand, ask what the child does not understand and clarify the issue for the child. If MA2=2 and MA3=2, end the test. Also test

children between the ages of 5 and 12 who are not attending school. WE’LL START WITH THE MATH TEST.

MA1. Line

no.

MA1A. Name

MA2. ARE YOU ABLE TO IDENTIFY

THE FOLLOWING NUMBERS?

Show Card

MA3. ARE YOU ABLE TO COUNT

THE FOLLOWING ITEMS? A. FOUR DOGS B. SEVEN FISH Show Card

MA4. OF THE NUMBERS BELOW, ARE YOU ABLE TO

IDENTIFY THE GREATER NUMBER? A. 7 8 B. 4 5 C. 9 2 Show Card

MA5. ARE YOU ABLE TO COMPLETE

THE FOLLOWING ADDITION? A. 4+2= B. 7+1= Show Card

MA6. ARE YOU ABLE TO COMPLETE THE

FOLLOWING SUBTRACTION?

A. 3-1= B. 8-5= Show Card

LINE NO.

NAME 3 9 FOUR DOGS SEVEN FISH 7 & 8 4 & 5 9 & 2 4+2 7+1 3-1 8-5

Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N

01 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

02 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

03 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

04 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

05 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

06 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

07 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

08 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

09 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

10 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

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FRENCH ASSESSMENT Village ID: ___ ___ ___ Household Number ___ ___ ___ FA To be administered for every child in the household age 5 through 12 years. NOW, I’M GOING TO ASK YOU THE QUESTIONS FOR THE FRENCH TEST. CHILD’S REACTION TIME = 1 MINUTE AT MOST

FA1.

Line

no.

FA1.

Name

FA2. ARE YOU ABLE TO IDENTIFY

THE FOLLOWING LETTERS?

Show Card

FA3.

ARE YOU ABLE TO READ

THE FOLLOWING WORDS?

Show Card

FA4.

ARE YOU ABLE TO READ THE

FOLLOWING MORE DIFFICULT

WORDS? A. ÉCOLE B. TOMATE

Show Card

FA5.

ARE YOU ABLE TO IDENTIFY

THE CORRECT MISSING

WORD?

Le garcon achète un ____.

A. HEUREUX B. BONBON C. EST

Show Card

FA6.

ARE YOU ABLE TO

IDENTIFY THE CORRECT

MISSING WORD?

La fille ____ aller à

l’école.

A. JOUR B. CHEMIN C. AIME

Show Card

LINE C T PAPA VÉLO ÉCOLE TOMATE BONBON AIME

NO. NAME Y N Y N Y N Y N Y N Y N Y N Y N

01 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

02 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

03 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

04 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

05 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

06 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

07 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

08 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

09 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

10 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2

Documents

MICS Household Questionnaire